Rewards Program Sign-up

Earn Away

You’ve asked for it, and now we’ve got it. The Getaway Café Rewards Card to show our appreciation to you, our valued customer. It’ free… It’s easy… Best of all, it lets you earn discount points (?) each time you dine in or take out. What are you waiting for? Sign up today and earn away…

Confidential Member Profile

1. Gender
2. Title Mr. Mrs. Miss Ms Other
3. Other
4. Last Name
5. MI
6. Apt/Unit
7. Address
8. City
9. State/Province Select state/province Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Territories Military -- AA Military -- AE Military -- AP Not Applicable
10. ZIP/Postal Code
11. Home Phone
12. Business Phone
13. FAX
14. Email
15. Birth Date

    1. Month
    2. Day
    3. Year
16. Anniversay Date

    1. Month
    2. Day
    3. Year
17. Additional members:

    1. Last Name:

    1. First Name: MI:

    1. Month Day Year

    1. Additional Card Desired:

    1. Add more additional members?

18. Providing this information constitutes your permission for Getaway Cafe to contact you via email, fax or phone for various updates related to your membership or events at Getaway Cafe.

    I agree to the Terms of Agreement